Fmc Skyway

“IC-WEAR GLOVES/HAND HYGIENE CFR(s): 494.30(a)(1) Wear disposable gloves when caring for the patient or touching the patient’s equipment at the dialysis station. Staff must remove gloves and wash hands between each patient or station. This Standard is not met as evidenced by: 27405 Based on policy review, observation and interview, the facility failed to ensure proper hand hygiene to prevent the spread of potentially infectious bacteria was performed by 1 clinical staff provider (Nurse Practitioner A) and by 4 patients (Patient’s #6, #4, #7 and #5) of 9 patients observed during 1 of 2 days of observations of direct patient care. The findings include: Review of the facility policy titled, “Hand Hygiene,” dated 11/6/2023, revealed “...Patients should perform hand hygiene if able, prior to and after each dialysis treatment...to help ensure the prevention of cross contamination to their family members or other patients, hand hygiene must be performed...” Observations were conducted of the treatment floor on 11/18/2024 from 10:10 AM through 11:46 AM, the following staff were present during the observation: 2 Registered Nurses (RN) 1 Licensed Practical Nurse (LPN), and 3 Certified Clinical Hemodialysis Technician (CCHT). Fifteen patients were present in the treatment area during the time period. The following concerns were observed: At 10:10 AM, Patient #6 had completed his dialysis treatment and exited the station accompanied by staff, Patient #6 proceeded through the exit door without sanitizing the hands before exiting the treatment area. At 10:32 AM, Patient #4 had completed his dialysis treatment and exited the station accompanied by staff, Patient #4 proceeded through the exit door without sanitizing the hands before exiting the treatment area. At 11:05 AM, Patient #7 had completed her dialysis treatment and exited the station accompanied by staff, Patient #7 proceeded through the exit door without sanitizing the hands before exiting the treatment area. At 11:13 AM, Nurse Practitioner (NP) A was observed walking into the dialysis treatment area and stopped at station #7 to observe and record data from the dialysis machine. NP A, with her ungloved right hand proceeded to touch the dialysis machine screen. NP A repeated touching the dialysis machine screen and proceeded to record the data from the dialysis machine into her cell phone. NP A exited station #7 and proceeded to the nurses station. NP A failed to sanitize the hands after touching the dialysis machine screen and exiting station #7. At 11:46 AM, Patient #5 had completed her dialysis treatment and exited the station accompanied by staff, Patient #5 proceeded through the exit door without sanitizing the hands before exiting the treatment area. During an interview on 11/20/2024 at 12:15 PM, the Clinical Manager confirmed hand hygiene must be performed according to facility policy by patients as well as staff before exiting the dialysis treatment area and after touching inanimate objects (e.g. dialysis machine, stethoscope) in the patient treatment stations.”

“POC-VASCULAR ACCESS-MONITOR/REFERRALS CFR(s): 494.90(a)(5) The interdisciplinary team must provide vascular access monitoring and appropriate, timely referrals to achieve and sustain vascular access. The hemodialysis patient must be evaluated for the appropriate vascular access type, taking into consideration co-morbid conditions, other risk factors, and whether the patient is a potential candidate for arteriovenous fistula placement. This Standard is not met as evidenced by: 40606 Based on facility policy review, medical record review, observation and interview, the facility failed to maintain safety measures for 2 patients (Patient #9 and Patient #8), when clamps were applied to Patient’s #9 and #8’s arteriovenous fistula (AVF), of 5 patients observed with clamps applied to their AVF dialysis access. The findings include: Review of the facility’s policy titled, “Venipuncture Site Clamps Procedure,” dated 7/5/2022, showed “...procedure is to provide guidance for when pressure clamps may be used for hemostasis [to stop the flow of blood] for an emergency and/or rare use on the fistula or graft cannulation sites post treatment...Policy...An order by the treating physician is required for venipuncture site clamp usage...Use only one clamp at a time to prevent excessive pressure which can cause thrombosis...9. Check the access for the presence of a thrill [indication of pulsation]. If a thrill is not present adjust the clamp until you can feel a continuous thrill...” Patient #9 was admitted to the facility for hemodialysis on 7/29/2018, with diagnoses including Impaired Renal Tubular Function and End Stage Renal Disease. Medical record review of Patient #9’s physician’s orders revealed a “Special Attention” order, dated 9/18/2024, “Ok to use clamp on access post tx [treatment].” During observation of Patient #9 on 11/18/2024 at 10:10 AM, seated in station #8, showed the hemodialysis treatment ended and Certified Clinical Hemodialysis Technician (CCHT) B applied a clamp to the venipuncture site after the dialysis needle was removed. Observation revealed the CCHT did not check for pulsation in the access after the clamp was applied. Patient #8 was admitted to the facility for hemodialysis on 2/8/2020, with diagnoses including Hypertensive Chronic Kidney Disease and End Stage Renal Disease. Medical record review of Patient #8’s physician’s orders revealed a “Special Attention” order, dated 11/15/2024, “Ok to use clamp on access post tx [treatment].” During observation of Patient #8 on 11/18/2024 at 10:32 AM, seated in station #4, showed the hemodialysis treatment ended and Certified Clinical Hemodialysis Technician (CCHT) C applied a clamp to the first venipuncture site after the dialysis needle was removed. Observation revealed the CCHT did not check for pulsation in the access after the clamp was applied. Observation continued at 10:50 AM, a clamp was applied to the second venipuncture site after the dialysis needle was removed, and CCHT C did not check for pulsation in the access after the clamp was applied. During interview with the Clinical Manager on 11/20/2024 at 11:30 AM, she confirmed the observations of clamp usage on 11/18/2024, did not comply with the safe use of clamps to promote preservation of the patients’ fistulae [dialysis access].”